Pre-submission claims QA / QC

Stop denials before
they leave the building.

Most revenue-cycle tools find denials after a payer sends them back. ARIA catches the defective claim first — at the gate, before it's ever submitted — so it never becomes a denial, an appeal, or three weeks of rework.

NCCI-gated rules engine
Sovereign on-prem or BAA-covered
837 / 835 native
The bleed

A denied claim is a defect you already paid to produce.

By the time a payer rejects a claim, the work is done twice: once to submit it, again to find it, fix it, and resubmit it — if it gets reworked at all. Reactive RCM treats denials as a fact of life. They aren't. They're escaped defects.

01 · COST

Rework is the most expensive way to bill

Every denial carries the cost of the original submission plus the appeal, the follow-up, and the days that claim sits unpaid. The cheapest claim is the one that goes out clean the first time.

02 · TIMING

Detection happens too late to matter

Dashboards that report denial rates are reporting history. The decision that created the denial was made weeks earlier, at submission — the one moment reactive tools don't touch.

03 · PATTERN

The same defects repeat, silently

Duplicate lines, timely-filing misses, modifier mismatches, credentialing gaps — the same failure modes recur because nothing inspects the claim at the point it can still be fixed for free.

The gate

ARIA inspects every claim before it's submitted.

It sits between your billing workflow and the payer as a pre-submission checkpoint. Each claim is read, tested against the rules, and either cleared, held, or routed for correction — before it ever reaches a clearinghouse.

STEP 01

Ingest the claim

ARIA reads the outbound 837 and reconciles against the 835 remittance history — the same transactions your system already produces.

X12 · 837P / 837I · 835
STEP 02

Run the gate

An NCCI-gated rules engine tests each claim against coding, coverage, timely-filing, modifier, and payer-variance logic validated on real adjudication data.

NCCI-gated · payer-variance
STEP 03

Classify & hold

Defects are ranked by severity — hard-block, flag-for-review, or advisory — so a blocking error is stopped while a clean claim passes untouched.

P1 block · P2 warn · P3 advisory
STEP 04

Correct & coach

Held claims come back with the specific defect and the fix. Recurring patterns surface as coaching so the same defect stops happening at the source.

defect log · biller coaching
First-pass results

Caught before a single claim reached a payer.

Aggregate, de-identified results across ARIA's pilot deployments — payer-side exposure intercepted at the pre-submission gate rather than denied downstream.

Exposure intercepted
~$148K
payer-side revenue caught pre-submission
Claims stopped
417
flagged, held & routed for correction
First-pass acceptance
88%
clean through with no blocking defect
Engine validation
1.6M
CMS records validated before a live 837
Aggregate, de-identified pilot results — not a payer or provider disclosure.
Reserved for named-client proof. Practice logos and a results quote drop in here once written permission is on file — a signed client reference is a stronger asset than any statistic, and it stays compliant.
PENDING SIGN-OFF
Sovereign by design

Built so PHI never has to leave your control.

ARIA is architected for practices and partners that treat patient data as non-negotiable. You choose where it runs; the privacy posture holds either way.

On-prem or BAA-covered cloud

Run ARIA on sovereign on-premises infrastructure inside your own walls, or as a BAA-covered managed deployment. Same engine, same rules, your choice of environment.

De-identified before inference

Claim content is tokenized and de-identified before it ever reaches a model inference layer. Identifiable PHI is not transmitted to third-party model services.

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HIPAA-aligned, BAA-backed

Deployments operate under a Business Associate Agreement with administrative, physical, and technical safeguards consistent with the HIPAA Security Rule.

Analytical, not a record store

ARIA inspects claims in flight rather than warehousing a designated record set — a smaller footprint and a cleaner data-handling posture by design.

Who it's for

Independent practices and the partners who bill for them.

Behavioral health

Psychiatry & counseling

High telehealth volume, modifier-sensitive coding, and payer-specific rules make behavioral health a discipline where pre-submission QA pays for itself fast.

Specialty therapy

Speech, OT & PT

Session-based billing with tight authorization and timely-filing windows — exactly the defects the gate is built to catch before they cost a claim.

RCM partners

Billing & recovery firms

License ARIA as a pre-submission QA layer across your book of business and hand clients cleaner first-pass rates without adding headcount.

See what ARIA catches on your claims.

Book a working demo. We'll walk through the gate on real transaction types from your specialty and show you the defects it stops before submission.

Rob Cushard · NTH Simple Solution · rob.cushard@nthsimplesolution.com